1171-02 - 920 NASH ST N (3)VERSION 12.2000
OWNER -BUILDER DECLARATION
I hereby affirm under penally of penury that I am exempt from the Uneaten
License Law to the follelnrrt reason (Sec 10f 1 5 Business and Professions Code
My cry or peaty which requires a permit to consWd. alter. Improve, demolish, or
raper any structure, poor to es issuance, also rewires Me apWUnt to such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the -
Contractors License Law (Chapter 9 (commencing rMh Sec 7000) of Div 3 of the
Busmen end Proessmns Code) or that he or she Is exempt thereham aria pre basis
for the exemption My violation of Sec 7031 5 by any applicant for a perms
the applicant to a avr penaltyof not rive than five hundred dollars (S500)) ,
I. as omit of ON property. or my employees with wages as per sole oem-
pensaaan. yell do OW work, end the structure Is not Intended a offered for sale (Sec
7044, Business and Professions Code The Contractors License Law does not
apply to an owner of property who builds a Improves thereon. and who does such
work himself or herself or Bragh ha a her oem employees prowled pat such
Improvements are not mended or offered for sale If, fps ever, the to dmg or im-
provement m sold wino -tone year of oompleaon the oner{aaber will have the
burden
a [room that hew she did not build or improve for pre purpose of sale I
I, as owner of the properly, am exclusively contracting with Licensed con-
ir ors to construct the protect (Sec 704e Business end Professions Code The
Contractors License Law does not apply to an owner of properly who builds or Im
proves thereon, and who contracts for such proiecls ire h a contractor(s) scene
pursuant to the Contractors License Law )
under Section B 8P C to this reason
I``♦'' I``amI��I
'�exempt
•'4'cat_ A
Dee Svutae of Owner
UCENSED CONTRACTORS DECLARATION
I hereby ahem under penalty of penury that I am licensed under prowsrons of
Chapter 9 (commencing with 000) of Dmsron 3 of the Business and
Professions Code and my Manse is fu arcs a enect
license Class N ber Expiration Date
Date _ Sq a of Gonads _
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of penury one of the following declarations
I have and WI maintain a certdcale of consent to self -insure fa workers'
canpensation as provided for by Section 3703 of the Labor Code Ili erg per -
lenience the for
of work which Des peon I Is Issued
q I nave end eau maintain workers compensation Insurance es required by
Sec aWU of Me Labor Lode tor the penormance of me work to winch Ins permit
Is issued My workers compensation Insurance carrier and policy number are
Carter
ei Ciro
111n mom halo me be anarhae l M pies a 4ww naiad Yobs Wan a inn
i I candy that n the performance of the was to Weal ees peathe issued,
its employ any person m any manner so as to become o become
to dthe
taws andf pee Mat shllftopre
mit rs'
cCabfprua
oern oft ebramme I
waters' compensations Secd3100the Labor Code IstWlforthwith
mMOUE
mpN Wth e s
at Signature of MWcant
WARNING FAILURE TO SECURE ISOMERS COWENSATION
COVERAGE R UNLAWFUL, AND SMALL SUBJECT AN EAWLOYER IO
CAWtAL PENALTIES AND CML FRIES UP 10 ONE MUNOREO
RIOUSANDDOLLARS fS10A000A IN ADa11UN TO THE COST OF _
CONFENSA IX* DAMIGES AS RIO76lVR RI SECTION d OF
ISM LABOR CODE, INTEREST D ATTORNEYS FEES.
CONSTRUCTION LADING AGENCY
I hereby affirm abler penalty of I there is a conseudcn lending agency
foe the performance of the work for this permit is issued (Sec 3097 Qv C I
Lender's Name
Lender Address I _ ,
I certify that I have road this application and state (haulm above mlonnabon Is
cared I agree to crimpy w th all city and county ordinances and stale laws to
laem to budano construction, and hereby autlgnte representatives a ens city
to` enter Won De adWe9ha vnM roperry 1
�V
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SgMlae Apofcanla Acetyl
BUILDING PERMIT
BUILDING SAFETY DIVISION
COMMUNITY. ECONOMIC & DEVELOPMENT
SERVICES DEPARTMENT
350 Main Street
El Segundo. CA 90245
SITEADDRESS �• _
v Sh 3‘1��
LUTE I IDENTIFYING NUMBER
ASSESSOR PARCEL NUMBER
BOOK PAGE PARCEL
APPL ANT //CCOaNTTACTt PERSON fYY 1 \
Li\XX �?a9. V\cs c\
DA`irE G
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ZIP
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STATE (�
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ZIP
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9 a'4 J
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PHONE NO .-
ADDRESS _
CITY
STATE
ZIP
ENGINEER
PHONE NO
ADDRESS
CITY
STATE
ZIP
NTRACI OR S NAME ,
-nv�-tvC
LIfV LIC NO
A RESS
PHONE NO
1
CITY
STATE
lip
PLAN CHECK/PERMIT NUMBER:P y,.A L
USE BWG AREA
LMRNEVIIOENTIAL
NEW . fJ
Lim) USE �BLUG AREA
ADDITION
COMMERCIAL
LMP USE
SLUG AREA
ALTERATION
1%St
WORK
YG'C� N`
\•SKTA�9rY
yN,gyNIPTTIION�O
Sry
TYPEISI OF CONSTRUCTIS
SSW
RE p
OCC GRO0 ISI
SOUARE FOOTAGE
NO OF STORIES
FIRE SPRINKLERS
CS NO
STATISTICAL CLASSIFICATIOr
ro
UNITISI
CODE IN EFFECT
$
PLAN CHECK FE' S
ENERGY PLAN CHECK S
VALUATION
`RELLIPT NUMBER
INITIALS
DATE
S
PLAN CHECK FEE S
ENERGY PLAN CHECK S
REVISED VALUATION
'ELEIPT NUMBER
F 1501IALS
DATE
PERMIT FEE S
RETENTION FEE S
SMIP FEE S
ACCELERATED FEE 5
TOTAL BUILDING PERMIT FEE S
3 0
Z
3 2
IEESPAID
DIST PAID
WORKS FEES PD
PERMIT OBTAINED
APPROVAL
APPROVAL
APPROVAL
WASTE APPROVAL
I I SCHOOL
_ HEALTH DEPT
SANITATION
1—) FIRE DEPT
j—, SCAOMD
MIPUBLIC
E 1 OSHA
r1 INDUSTRIAL
.13EE�CEIPT
NUMBER
IDR0
OS
INIT S
DATE (,- -
Fa
pA'E_Id-OZ
INSPECTION (
DATE
INSPECTOR
REQUIRED BUILDING INSPECTIONS AND APPROVALS
BI
Laskin and setbacks
82.
Sob Enp nws Approval
SI
Faatlatonarenh tine .
Ba'
SmRbral mae* ebb al Bade
115
Raid fen Fanny
M
Under foci awia6on
BT
Feel lend fen stleathng
08
Second level boa sheathay
00
Turd level 6m sheathing
810
Rodpeamng
811
Concrete block
1st Grout Nt
and Grout Mt
Sid Gird Si
MI Grout Si
B12
Steel kammg
813
Fie Cep Mine nspecbon
B1e
BWdlg Dept framebapeclon
816
En water hangers
B1S
MulittonMenher sWppleg
St?
Miner tarn anddidryeal
610
Exterior ath
BID
RsledloalCeiy assembles
820
Rand wall assemfns
821
Rated oparrg Irolecbon
an
Rated slap wrnFur.6m
023
T-0XLaengf
824
Lol Cartage
825
Mandl' Deg Appeval
826
Fee Dept Approval
02?
Pubic Wake Dept Mpovat
'BM
Fri Brtmy rupcEdl removal
DESCRIBE COMPLETELY THE INTENDED USE OF AU. SPACE APPLICABLE TO THIS BUILDING PERMN
The following statement must be signed by the Building owner.
(linen apprond by the Building ORklat the myna agent may sign for pannha other than the Initial or shell building permit
We the app&anl or Mute bulging occupant tunce a hazardous mineral a motors containing a hannbus malerul equal to or dreams than Me amount
speeded crime hazardous nelnis nbmebon guide? Yes a Nd new
e the answer to the question was yes. w8 the proposed bulby a mod -fed faddy be whin 1000 feet of the outer boundary of a saes?
Yea or No new
I have read Me hazardous matenal Soimabon guide and he SCAOMD pemMbng dlaklsl I understand my requirement under the State of California
Mani and Safety Code Section 25505 25533, and 25634 concerning hazardous matenab reporting Yes or No fuck,
NAME SIGNATURE
INSPECTION NOTES:
II.. rg1W
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CITY OF EL SEGUNDO
pDDEPT Of BUILDING & SAFE(Y
OWNER
•.-3 ADDRESS o ALfi'� ty
z'e s A's : C €C g GROUP TYPE CONST ---"--' T _A4PORARY
;AI E LIDZ //�
E A +ENT _ PLAN C 1ECK NO iL1- .
ROUTING
DATE SIGNATURE
/CHITEC7URAUSi �UCTJ�• 01
ENERGY STANDARD
ELECTRICAL
V CH & PLUMBING
`'REPREVEN-�10`'
RUC WORKS
/_
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•••
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• • . • ••
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.
JANITORIAL SUPPLY
WAREHOUSE
OPEN TO THE POOEICI-
TO'd
El Computer Systems, Inc.
A California Corporation
0 B.A.
ria
920 Nash Street
Building B
El Segundo, CA 90245
Tel: 310/416-1200
Fax: 310/416-1443
info@conticorn p.com
www.conticomp.com
:86
To whom it may concern. 11-18-02
9I:TT c96'c—BT—f1OtJ
ROK Holdings LLC. is the owner of the building at 920 Nash St.
El Segundo,CA.and hereby authorizes Waxie's representative
Kalmele Floyd to apply for a Permit to temporarily install a sign on the side of
the building stating:WAREHOUSE OPEN TO THE PUBLIC.
Please feel free to contact me at any time.
Truly
Ezie Isaac/Manager/Owner.
ROK Holdings LLC